Atopic Dermatitis Follow-up

  • Author: Bernice R Krafchik, MBChB, FRCPC; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 24, 2011
 

Further Outpatient Care

  • Monitor atopic dermatitis patients frequently.
  • Reinforce therapeutic regimens with patients.
Next

Inpatient & Outpatient Medications

  • Medications are used as described in Medication.
Previous
Next

Deterrence/Prevention

  • Moisturization is important on an ongoing basis and may prevent flares.
Previous
Next

Complications

  • If topical corticosteroids are used inappropriately or if superpotent steroids are used in teenagers during rapid growth, striae may occur. Skin thinning can result if steroids are used inappropriately in older patients.
  • Whether verrucae vulgaris and mollusca contagiosa are more frequent is difficult to assess, but they are more widespread and difficult to eliminate.
  • Tachyphylaxis to topical steroids occurs if they are not used on a stop-start basis.
Previous
Next

Prognosis

  • Most patients improve; this can occur at any age. While the frequency of atopic dermatitis is as high as 20% in childhood,[23] it is 0.9% in adults.
  • One third of patients develop allergic rhinitis.
  • One third of patients develop asthma.
Previous
Next

Patient Education

  • Frequently reinforce treatment and maintenance regimens with patients.
  • Advise patients to contact the National Eczema Association for Science and Education at 4460 Redwood Hwy, Suite 16-D, San Rafael, CA 94903-1953.
  • Inform patients that treatment does not produce cure but good control can be achieved
  • Show videos to patients that show how to apply medication and that discuss the role of moisturization.
  • A randomized controlled trial by Armstrong et al demonstrated improved patient education and clinical outcome in patients who watched a video on atopic dermatitis compared with those who received a pamphlet.[24] The study emphasized the importance of lifestyle changes and daily care in the successful treatment of atopic dermatitis.
  • For excellent patient education resources, visit eMedicine's Skin, Hair, and Nails Center. Also, see eMedicine's patient education article Eczema.
Previous
 
Contributor Information and Disclosures
Author

Bernice R Krafchik, MBChB, FRCPC  Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter Fritsch, MD  Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Jansen CT, Haapalahti J, Hopsu-Havu VK. Immunoglobulin E in the human atopic skin. Arch Dermatol Forsch. May 28 1973;246(4):209-302. [Medline].

  2. Callard RE, Harper JI. The skin barrier, atopic dermatitis and allergy: a role for Langerhans cells?. Trends Immunol. Jul 2007;28(7):294-8. [Medline].

  3. Irvine AD. Fleshing out filaggrin phenotypes. J Invest Dermatol. Mar 2007;127(3):504-7. [Medline].

  4. Sandilands A, Smith FJ, Irvine AD, McLean WH. Filaggrin's fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol. Jun 2007;127(6):1282-4. [Medline].

  5. Horii KA, Simon SD, Liu DY, Sharma V. Atopic dermatitis in children in the United States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns. Pediatrics. Sep 2007;120(3):e527-34. [Medline].

  6. Williams HC, Pembroke AC, Forsdyke H, Boodoo G, Hay RJ, Burney PG. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol. Feb 1995;32(2 Pt 1):212-7. [Medline].

  7. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980;92 (suppl):44-7.

  8. Morar N, Willis-Owen SA, Moffatt MF, Cookson WO. The genetics of atopic dermatitis. J Allergy Clin Immunol. Jul 2006;118(1):24-34; quiz 35-6. [Medline].

  9. Novak N, Bieber T, Leung DY. Immune mechanisms leading to atopic dermatitis. J Allergy Clin Immunol. Dec 2003;112(6 Suppl):S128-39. [Medline].

  10. Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol. Jul 2006;118(1):209-13. [Medline].

  11. Zutavern A, Hirsch T, Leupold W, Weiland S, Keil U, von Mutius E. Atopic dermatitis, extrinsic atopic dermatitis and the hygiene hypothesis: results from a cross-sectional study. Clin Exp Allergy. Oct 2005;35(10):1301-8. [Medline].

  12. [Best Evidence] Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child. Sep 2005;90(9):892-7. [Medline].

  13. Lee CH, Chuang HY, Hong CH, et al. Lifetime exposure to cigarette smoking and the development of adult-onset atopic dermatitis. Br J Dermatol. Mar 2011;164(3):483-9. [Medline]. [Full Text].

  14. Schmitt J, Chen CM, Apfelbacher C, et al. Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus. Allergy. Mar 2011;66(3):404-11. [Medline].

  15. Nikkels AF, Piérard GE. Occult varicella. Pediatr Infect Dis J. Dec 2009;28(12):1073-5. [Medline].

  16. Baumer JH. Guideline review: atopic eczema in children, NICE. Arch Dis Child. Apr 1 2008;[Medline].

  17. Haeck IM, Rouwen TJ, Timmer-de Mik L, et al. Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol. Feb 2011;64(2):275-81. [Medline].

  18. Michail S. The role of Probiotics in allergic diseases. Allergy Asthma Clin Immunol. Oct 22 2009;5(1):5. [Medline].

  19. Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol. Jul 2007;157(1):127-32. [Medline].

  20. Van Velsen SG, Haeck IM, Bruijnzeel-Koomen CA. Severe atopic dermatitis treated with everolimus. J Dermatolog Treat. 2009;20(6):365-7. [Medline].

  21. Feldman SR. Adherence must always be considered: is everolimus really ineffective as a treatment for atopic dermatitis?. J Dermatolog Treat. 2009;20(6):317-8. [Medline].

  22. Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. May 2009;123(5):e808-14. [Medline].

  23. Leung DY, Bieber T. Atopic dermatitis. Lancet. Jan 11 2003;361(9352):151-60. [Medline].

  24. Armstrong AW, Kim RH, Idriss NZ, Larsen LN, Lio PA. Online video improves clinical outcomes in adults with atopic dermatitis: a randomized controlled trial. J Am Acad Dermatol. Mar 2011;64(3):502-7. [Medline].

  25. Abramovits W. Atopic dermatitis. J Am Acad Dermatol. Jul 2005;53(1 Suppl 1):S86-93. [Medline].

  26. Bieber T. Atopic dermatitis. N Engl J Med. Apr 3 2008;358(14):1483-94. [Medline].

  27. Boguniewicz M, Eichenfield LF, Hultsch T. Current management of atopic dermatitis and interruption of the atopic march. J Allergy Clin Immunol. Dec 2003;112(6 Suppl):S140-50. [Medline].

  28. Krafchik BR. Eczematous dermatitis. In: Schachner LA, Hansen RD, eds. Pediatric Dermatology. Vol 1. 2nd ed. New York, NY: Churchill Livingstone; 1998:685-721.

  29. Lebwohl M, Friedlander S. New strategies for optimizing the treatment of inflammatory dermatoses with topical corticosteroids in an era of corticosteroid-sparing regimens. J Am Acad Dermatol. Jul 2005;53 (1 Pt 2):S1-S2.

  30. Leung DY, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest. Mar 2004;113(5):651-7. [Medline].

  31. Simpson EL, Hanifin JM. Atopic dermatitis. J Am Acad Dermatol. Jul 2005;53(1):115-28. [Medline].

  32. Williams HC. Clinical practice. Atopic dermatitis. N Engl J Med. Jun 2 2005;352(22):2314-24. [Medline].

 
Previous
Next
 
Typical atopic dermatitis on the face of an infant.
Flexural involvement in childhood atopic dermatitis.
Dirty neck sign in chronic atopic dermatitis.
Irritation around mouth of an infant with atopic dermatitis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.